In this episode, Stephen Jones, M.D., President & CEO of Inova Health System, joins Renee at The Table. They explore how Inova being an early mover in requiring the COVID vaccine for employees brings a competitive advantage, how Stephen has implemented the ‘care first’ vision throughout the organization, and the ongoing work that Inova is doing to build a culture of well-being and safety for employees.
J. Stephen Jones, MD, is President and CEO of Inova, the Washington, DC region’s leading not-for-profit healthcare system serving more than 2 million people annually in its five hospitals and numerous ambulatory programs. He is also Professor of Urology at the University of Virginia, which is working with Inova to bring undergraduate medical education and expanded research to the flagship Inova Fairfax Medical Campus. Read more…
Renee DeSilva 0:06
Welcome back to the Academy Table. I’m Renee DeSilva, CEO of The Academy and your host and we’re happy to have you back with us again. As some of you may know, I have the pleasure of sitting on the board of the Inova Health System here in Northern Virginia. Of course, in that capacity, I’ve had the pleasure of getting to know Dr. Stephen Jones, the President and CEO, who is also our guest today. Stephen is a humble, clear, and focused leader and I think that comes through in our discussion today. Since joining Inova three years ago he has driven the organization to become relentlessly focused on patient care and quality or as I like to call it, back to basics and bringing sexy back. A couple of things I’d like you to listen for. First, pay attention to the many ways Stephen has integrated that ‘care first’ vision throughout the organization. Across our conversation, he addresses how this mindset applies to all things and all people — from new hospital projects to research, from clinicians to IT experts. Next, Stephen shares the ongoing work Inova is doing to build a culture of well-being and safety for employees. Now more than ever, health systems across the country are entering well-being as a core value, not just another initiative and Stephen shares his approach on this journey. Lastly, Inova was an early mover in announcing a COVID vaccine requirement for all employees at the beginning of June. I love Stephen’s explanation of their decision-making process around that and how he views that requirement as a competitive advantage in attracting talent and patients alike. With that, let’s head to The Table.
Stephen, welcome to The Table. Happy to have you here today.
Stephen Jones 1:54
It’s a pleasure. Appreciate the opportunity to be with you.
Renee DeSilva 1:56
Two weeks ago we were having a conversation with many of your health system CEO peers on the topic of, “What do we all collectively see as the vision for healthcare taking a 10-year aperture?” We call this “Horizon 2030.” As you recall, we talked about many of these forces converging — the future of consumers, how do we think through payer and provider relationships, how do we meet the needs of our workforce? I wondered if you could comment on your vision for Inova in the context of all of these themes.
Stephen Jones 2:31
People tend to predict huge changes in the future, most of which don’t end up coming true. I guess my bold prediction is that I think that things will be less changed than a lot of the visions that get thrown out there. I think what you’re going to see is that we’re going to increasingly have relationships and continuity of care, a connection to our patients across the continuum of care. I think what patients aren’t going to want is to be disaggregated as much as those predictions are coming quite the contrary. They want solutions for their problems from birth to end of life. I think that the biggest thing will be that you’ll see that get more realistic than some of the technical things that many people are talking about.
Renee DeSilva 3:19
I appreciate this about you in terms of your very practical, pragmatic approach to how you think about healthcare. Your response to that is in line with how I’ve gotten to know you across the last three years. When I think about your three years across the Inova system, I think about your relentless focus on getting back to basics — delivering solid patient care, all of the things that are table stakes but are not table stakes if we want to make sure that we’re delivering good care. In some ways, when I’ve seen your peers across the industry go to things like diversifying revenue beyond patient care or investing in innovation arms, I see you putting your head down and thinking through, how do I ensure that every interaction with the patient is high quality and physician lead or clinician lead? Talk to me about how you’ve thought about that over the three years that you’ve been leading the Inova system.
Stephen Jones 4:22
I think it’s tempting in every industry, including healthcare, to think in terms of how I change and do very different things. We know that throughout history, I think literature would suggest that that doesn’t succeed very often. That quote, “Sticking to your knitting is how people succeed.” I look at transformation as being my number one job. It all comes down to two key pieces which are developing the right culture and the right mindset, which are pretty related. It goes back to what you already talked about — having a relationship with patients. At the end of the day, if we can achieve a situation in which patients think of themselves as having their Inova, my Inova, then we will have solved the problems that they come to us to do. There have been three factors that I think are critical for us to do that — people, excellence, and becoming a true system. Everything we’ve done since the first day that I came to Inova has gone back to that. If you think about people, that’s the patient care that you’ve referenced and, of course, making us the best place for patients to get their care. Excellence, we, fortunately, had a great foundation before I came. Unlike what you’ve seen as criticisms of systems across the country, truly becoming a system built on our patients and not on any of the other things that we could get distracted by.
Renee DeSilva 5:44
If you stay with that relentless focus on your patients, and I think about this broader competition around the consumer, you want to create an environment where patients choose you, they are adhering to their care plan, they want to be engaged with you across the long term. I know a key part of your approach in ensuring that that stays enduring does come back to some of the investment around, I’ll call it the omnichannel, the physical infrastructure as well as the virtual components. Talk a little bit about the plans that you have for the Alexandria market, which for those folks who are not in Northern Virginia, is right outside of DC. While many of us are having this conversation around how we think about asset-light strategies, Inova is doing both — pursuing some physical infrastructure investment while wrapping that around virtual engagement. Talk through your plans for that project.
Stephen Jones 6:38
Many people are predicting the end of hospitals and that’s ridiculous. There will always be a need for physical care. If you look at the situation here with our new Alexandria hospital that we’re planning that you mentioned, hospitals will be procedure rooms, operating rooms, labor and delivery, intensive care units, and then some aliquot of beds that will be required for the things that happen after that before you’re ready to go home. What we’re doing is building in place of flexibility. I don’t know what healthcare is going to look like in 20 or 30 years, I’ve already told you that. The more flexible that the rooms are so that they can be an ICU or an inpatient room or potentially even an outpatient room if things go more ambulatory than even we all believe, then that flexibility will be there. The technical piece, because you mentioned our investment in that, will interrelate with what happens in the physical. If you go back to that connection with our patients, in my ideal world, they will be connected to us in some form electronically a lot of the time and physically when they need to. Again, we’re flexibly building this so that hopefully no matter what projections come forward, whatever we build and invest in will be able to be accommodated in that future.
Renee DeSilva 8:01
Stephen, in some ways, you’ve had the benefit of really seeing how COVID has impacted care delivery. Have you taken any of those real-time learnings and infused them into the plans for the new infrastructure?
Stephen Jones 8:11
It’s amazing how much COVID did affect that. It goes back to flexibility. When you saw how many rooms were converted to negative pressure last year by the dozens, literally over 200 rooms that we converted, our new facilities will be able to accommodate that preemptively. They won’t all be necessarily wired and have the HVAC end to be able to do air circulation, but if we have the next pandemic come along, we’ll be able to convert that. There’s a real expense to doing that, but we found out how expensive it can be to do it post hoc so we’re building that into all of our new facilities.
Renee DeSilva 8:49
I should say for our listeners that I get a chance to interact with you as a board member of Inova. I have an inside glimpse which has been a privilege for me. One of the things that I’ve appreciated is this construct of focusing on the basics and being of service to the community. You have been one of the early voices among health system leaders on the importance of mandating COVID vaccination for your employees. Can you talk about that in terms of why you decided to be an early mover on that? How has that decision played out now with the benefit of many of your peers also moving in that direction? When you announced it about a month ago, I think you were one of maybe a handful of health systems moving in that direction.
Stephen Jones 9:36
We were probably the fourth or fifth to mandate it. In other words, not only say we’re going to do it but give a date and make it a condition of employment. We were hopeful that more people would jump on quicker than has happened. I think we’re seeing a little bit of a capitulation on that now. It became clear to me that the science was too clear-cut on this. Many of my colleagues have said they want to wait on full FDA approval, but that’s a bureaucratic decision not a scientific one. We’ve got three and a half billion doses of these vaccines worldwide. At Inova, we’ve given almost a half-million doses ourselves until, frankly, people stop showing up. The science was so clear-cut that I didn’t see that waiting any longer would do anything other than put additional people at risk. As you see the surges that are coming right now, it’s clear to me that we probably should have considered doing this more quickly. Like everyone else, one of our concerns was the possibility that we would lose team members. We wanted to give people time to digest that and be respectful of the fact that there are reasonable reasons for people to be shy about getting the vaccines. But it became clear that science was going to drive our decision. It ties to our care mandates of following best evidence. We will lose some people as a result of that, but we hope that it’ll be people who eventually do decide that this is the safest thing to do and want to come back. Hopefully, we won’t have competitors who take advantage of that.
Renee DeSilva 11:06
I think that’s great. I applaud that move. We’re also seeing within health systems, within the broader industry, even the federal government announcing plans to move in that direction. That is a bright light. I want to stay on that science piece for a second. You are a physician by training, urology was your specialty, very well published on that. You lead with clinical acumen at the fore. When I’ve looked at how your leadership has focused on developing a service line model, with dyad, or sometimes triad disciplined leaders, having that clinical, operational, administrative nursing coming together. Talk to us a little bit about how that has played out across the last few years. What have been some of the benefits? Are there any drawbacks in your mind?
Stephen Jones 11:53
We are now a clinician-led organization. The CEO is a physician and you used the word “was.” I still am and I got into the clinic last week, actually. Obviously nowhere near as much as I used to, but that clinical focus goes out from me right to the frontlines. You mentioned triad leadership which I think has been one of the things that we were fortunate to think through, get great ideas that came mostly from people other than me, of course, which is how it should work. We have triad leadership not only at our clinical enterprise level, but in each of our clinical service lines and in our major sites which are a physician, a nurse, and an operations person. Initially, we were concerned that that would slow down decision-making. We’ve found that it’s exactly the opposite. You have the right voices there quickly as opposed to having to go through multiple committees, thought processes, and approvals. At the end of the day, you can come to our leadership triad, bring things forward, and we can make a decision in a few minutes. If for some reason that decision is not perfect, we can change it in a few minutes. The real test of that, of course, was when COVID hit and we had to change almost everything we did overnight. The fact that we had that triad leadership in place allowed us to respond more quickly than I could have ever dreamed that we would have. Again, nothing in this organization happens without a clinical focus including our nonpatient care. I even ask our IT people to think in terms of, you don’t fix a computer, you don’t make software and hardware work, you help a nurse take care of a patient, you help a nurse and a physician and respiratory therapist interact on what our patients need. When people embrace that their role is to do that instead of the technical pieces of it, then I think that we get not only the best people but the most committed people because they see their role as being part of clinical care.
Renee DeSilva 13:43
Tapping into the mission behind the work has never been more important, especially as we think about that in the context of some of the larger workforce and well-being challenges. Against the backdrop of a pretty traumatic year in terms of care delivery during COVID, I think we’re seeing a high level of burnout among clinicians and the broader healthcare workforce. Can you talk a little bit about how you have focused on well-being as part of your ongoing commitment to culture and transformation?
Stephen Jones 14:16
The well-being of our workforce is the thing that keeps me awake at night in the proverbial sense. Everything in Inova goes back to our mission to provide world-class healthcare and our values. If you take a look at all the stresses we’re under right now, when we stay focused on our mission to provide world-class healthcare and our values, including our people, then it allows us to take those things that look like decisions and they end up being simply tactics, not decisions because we decided to focus on, for example, the safety of our people. Whether it’s been how we’ve approached issues with COVID or racial injustice, we have taken all of that with our people as a value in a meaningful way. There are many specific things we’ve done, but my answer to the question of what the solution would be is that it’s about 1000 different things. It’s going to be different for each person who works for us. For some people, it’s going to be our compassion cards coming around just simply thanking them, some people need space, some people need more people around them, quite the opposite. We put in place everything that we can. When we talk to our team members, if it makes sense that we can support them, we put it in place. I’ll be happy to walk through any of those that you’re interested in.
Renee DeSilva 15:37
That’s great. I also note that all of this focus on well-being and meeting people where they are is against the backdrop of the fact that it’s even harder to recruit and retain talent. I don’t know if you have any comments on that. How do you think about meeting people where they are in terms of the folks that are with you? When we were together, we chatted about the notion that the talent competition has never been more fierce in healthcare. Comment a little bit about how you are thinking about that.
Stephen Jones 16:07
I’ll even go back to the vaccine mandate, Renee. Although one of our concerns is that we’ll lose some people who currently work in our organization, we want people who are looking for a job in healthcare to know that they can go to a place where we prioritize their safety. We’ve required that people be vaccinated. We believe that a majority of those folks will feel it’s preferable to work here because of what we’ve done. We certainly hope our patients will do that. From the very first day, I do onboarding with our team members every Monday morning that I’m physically able to. We talk about it right out of the gate that we recognize that we need to make this the best place for you to be. It goes to a lot of our work on inclusion. We want people to feel comfort in being in this organization at any given point in time. We keep that up. We connect with things like a buddy system so that you have someone who can be there to support you when we know that you may need that and not even be willing to speak it up. We have “Well-being Wednesday” where we have our Chief People Officer sending out an email with helpful tips. Sometimes they’re on mental health, sometimes they’re on mindfulness. One of the recent ones was simply on the fact that the Beltway traffic is getting worse and we know that sitting in traffic is a stressor for human beings, so even addressing that. We’ve tried to keep it an ongoing focus for our folks to know that we care about you, we want you to be who you are in our organization. We’ll keep asking until, hopefully, it doesn’t become annoying, what are the ways that we can support you? Even with doing that, the workforce scenario organization is struggling right now. We’re just not going to hide from it.
Renee DeSilva 17:46
That’s great. Related to that, your comment on sitting in traffic, we know that one of the major life dissatisfiers for people is their commute time. We’ve seen that. Outside of direct patient care delivery, I think many organizations have seen some success with hybrid work. Where are you on this remote, fully in-person, hybrid evolution that’s happening across healthcare, maybe the country more broadly?
Stephen Jones 18:08
I’ve put a lot of thought into this. We’re going to be a hybrid organization long-term. There are lots of folks who have to be physically here. Most basic direct patient care is still done physically. We’ve got areas such as revenue cycle and some other areas that probably never have to physically come in. For the majority of folks, especially our people leaders, I think the hybrid is going to be successful. I’ll take an example. I was out of town for a presentation that I had to do for a national audience in nursing healthcare. I was able to immediately go to a Zoom in which we were part of the monthly operations meeting which I couldn’t have done if I were out of town before. I was then able to go to a physical meeting there. The fact that you can indeed be in many different places, I think we’re going to be able to make work. There are a lot of organizations that have said, “You have to be 100% physical or 100% virtual.” I don’t buy that. We’ve found that we can make it work with a combination. I believe that that will be a long-term change for us. The other part I’ll add to that is that at the end of the day, all we are in healthcare are people taking care of other people. Everything else is just a tool for it. I believe that physical contact is important. I think that we will have more in-person leadership than in all likelihood other industries or maybe even others in healthcare.
Renee DeSilva 19:37
I think that’s right. I’m with you. In some ways we have found a way through virtual work that we can clone ourselves a bit; we can be in more than one place at the same time. I hope that some of that creativity stays intact. I’m with you on that. I want to go back to some of your earlier roots in healthcare. We talked about the fact that you’re still practicing, doing some amount of clinical work. You have such a strong background being part of the Cleveland Clinic before Inova in terms of the way that you think about research and infusing that into care delivery. Talk about how you think about that in the context of delivering care in a community-based health system. How does evidence-based care drive the way that you think about care delivery day to day at an organization like Inova?
Stephen Jones 20:27
It ties a little bit for us in redefining, not long after I came here, our mission and putting in place care imperatives. Our care imperative of best evidence forced us to make a decision on vaccines and also, by the way, led through many of the things as we’ve learned how to take care of this terrible disease. When we put our mission in place, we decided that our mission is not just to provide healthcare but to provide world-class healthcare. Although yes, that’s a tired term and we spent a lot of time trying to come up with a cuter word than that, world-class commands us to do research and education. You can’t be a world-class organization in healthcare without it. It focuses all of our research, education, and innovation on healthcare as opposed to some of the things that may be sexier but are not tied to that core business that we would focus on.
Renee DeSilva 21:22
Did you encounter any resistance as you were trying to reimagine how research gets embedded into the day-to-day DNA of the organization? Talk a little bit about how you pushed through that.
Stephen Jones 21:34
Fortunately, because I’m a scientist and editor of the American Neurological Association Journal, I think people see how much I value the science of medicine, which to me seems pretty self-evident, but maybe not to others. There was a little concern up front if we were discontinuing certain areas of research then maybe that’s going to become a lower priority for the organization. We discontinued areas of research that weren’t directly related to patient care. For example, we had a drug discovery program. Great science, no doubt that it’s important work but that’s work that over a couple of decades, you may or may not end up having something that matters as opposed to I’ve got patients in the ICU right now. Our research here is largely related to delivering better outcomes in care. We’ve seen it through COVID. We learned so many things in our research early on. I think it’s a big part of why we got so comfortable taking care of this disease within weeks as opposed to months through that research, through that experience, and through focusing on the best evidence.
Renee DeSilva 22:35
Through the lens of, right now, how do I help patients that are showing up? I think that’s great. I have a closing question for you which is part of the spirit of creating this podcast, The Table. We all know that one of the things that we’ve missed through the last 18 months has been the ability to come together with people in an in-person environment and get so much energy from that interaction. The question for you is, if you had an opportunity to curate your ideal table, two people around the table, who would you invite and why?
Stephen Jones 23:05
With all we’ve been through here, I would be most tempted to say my family, but for interest in this question, I think there are two people that I would enjoy setting and the three of us having a good conversation. Lou Gerstner who was a former CEO of IBM wrote the book, “Who Says Elephants Can’t Dance.” It’s about the transformation, 20 plus years ago by the way, of IBM. I recently reread his book. It was clear to me that almost everything he did in a completely different industry is almost identical to the things that we’re doing right now at Inova. It goes back to creating solutions for our customers. In his circumstance they were CIOs, in our circumstance, they are our patients. Being there as the solution or, as I mentioned to you, my Inova. The other person I would enjoy would be Amy Edmondson who is the mother, if you will, of the concept of teaming and, of course, the foundational principle of teaming being psychological safety. We’ve spent a lot of time here in developing that mindset and working on psychological safety and teaming, another one of our values by the way. The theme here is that with either of those they figured out a way to provide holistic solutions, whether it be building a team or satisfying customers, in our case, patients. To be able to take the best learnings from them and apply that in an integrated health system will set us up for a very bright future. I would welcome the opportunity if you could ever set that table up, I’ll buy.
Renee DeSilva 24:38
All right. I’m holding you to that. Thank you, Stephen. It’s always a pleasure chatting with you. I appreciate your vision for, I’ll say it as, bringing sexy back which in my mind is bringing back the basic elements of the power of sound patient care, the experience when you feel like you are in a system that’s delivering that in an integrated way. I’ve loved your vision for that and how that’s played out across the system. I am grateful as a consumer of all the great care that your colleagues provide. Thank you, as always, and good to catch up with you today.
Stephen Jones 25:14
It’s a privilege and I enjoy it very much. Thank you, Renee.
Renee DeSilva 25:17
Thanks again for joining me at The Table. The Table is a podcast produced by the Health Management Academy. Make sure you catch future episodes by visiting our website, theacademytable.com, or by subscribing on the podcast platform of your choice. If you have suggestions for topics or guests, I’d love to hear from you. Please drop me a note at firstname.lastname@example.org. I look forward to talking with you soon.